Discharge against medical advice: How often do we intervene?

Edwards, Jason; Markert, Ronald J.; Bricker, Dean

doi:10.1002/jhm.2087

Cited by 30 publications

(29 citation statements)

References 12 publications

(46 reference statements)

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“…These visit factors were reviewed because the literature has identified them as being important markers for AMA discharge safety. 6,8 Two research assistants, under the guidance of Dr. Stearns, reviewed the charts. To ensure agreement across chart reviews with respect to subjective questions (eg, whether capacity was adequately documented), the group reviewed the first 10 consecutive charts together; there was full agreement on how to classify the data of interest.…”

Section: Methodsmentioning

confidence: 99%

“…[10][11][12][13][14] Patients with mental illnesses and addiction issues are overrepresented in AMA discharges, and complicated capacity assessments and limited resources may strain providers. 7,8,15,16 Studies have repeatedly shown higher rates of readmission and mortality for AMA patients than for conventionally discharged patients. [17][18][19][20][21] Whether AMA discharge is a marker for other prognostic factors that bode poorly for patients or contributes to negative outcomes, data suggest this group of patients is vulnerable, having mortality rates up to 40% higher 1 year after discharge, relative to conventionally discharged patients.…”

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confidence: 99%

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Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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“…Discharge against medical advice impedes the ability of the healthcare team to provide timely care to the patient . Patients who leave the hospital with an informed refusal of inpatient care do not receive the same discharge care as patients discharged in a standard manner, with fewer DAMA patients receiving discharge plans, outpatient follow-up appointments and necessary prescriptions 21. Since patients who tend to leave against medical advice are less likely to have a primary doctor in the first place,22 there are greater potential negative consequences to them leaving without a discharge plan and follow-up.…”

Section: Rethinking Discharge Against Medical Advice As a Healthcare mentioning

confidence: 99%

Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap?

et al. 2019

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“…Patients who leave against medical advice represent a public health and financial concern. They are at increased risk of mortality, morbidity, and readmission and are likely to consume a disproportionate share of increasingly scarce healthcare resources [4,11,13,18,40,44].…”

Section: Introductionmentioning

confidence: 99%

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

Menendez

Dijk

Ring

2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients who leave the hospital against medical advice are at risk for readmission and for a variety of complications and are likely to consume more healthcare resources. However, little is known about which factors, if any, may be associated with self-discharge (discharge against medical advice) among orthopaedic inpatients. Questions/purposes We studied the frequency and factors associated with self-discharge in patients hospitalized for orthopaedic trauma and musculoskeletal infection. Methods Using discharge records from the Nationwide Inpatient Sample (2002-2011), we identified approximately 7,067,432 patient hospitalizations for orthopaedic trauma and 5,488,686 for musculoskeletal infection. We calculated the proportions of admissions that ended in selfdischarge for both trauma and infection patients; then, we examined patient demographics, diagnoses, and hospital factors. Multivariable logistic regression models were constructed to determine independent predictors of selfdischarge. Results Approximately one in 333 (0.3%) patients hospitalized for an isolated fracture and one in 47 (2.1%) patients with musculoskeletal infection left against medical advice. Patient characteristics associated with self-discharge included age \ 75 years (trauma: odds ratio [OR] 2.7, 95% confidence interval [CI] 2.5-2.8, p \ 0.001; infection: OR 3.9, 95% CI 3.8-4.1, p \ 0.001), male sex (trauma: OR 1.7, 95% CI 1.7-1.8, p\0.001; infection: OR 1.4, 95% CI 1.3-1.4, p \ 0.001), black race/ethnicity (trauma: OR 1.5, 95% CI 1.4-1.6, p\0.001; infection: OR 1.1, 95% CI 1.1-1.1, p \ 0.001), low household income (trauma: OR 1.5, 95% CI 1.4-1.5, p\0.001; infection: OR 1.4, 95% CI 1.4-1.4, p \ 0.001), nonprivate insurance (Medicare [trauma: OR 1.7, 95% CI 1.6-1.8, p \ 0.001; infection: OR 2.5, 95% CI 2.4-2.5, p \ 0.001] and Medicaid [trauma: OR 2.6, 95% CI 2.5-2.7, p \ 0.001; infection: OR 3.2, 95% CI 3.2-3.3, p \ 0.001]), and no insurance coverage (trauma: OR 3.0, 95% CI 2.9-3.1, p \ 0.001; infection: OR 3.5, 95% CI 3.4-3.5, p \ 0.001), less medical comorbidity (trauma: OR 0.94 per one-unit increase in the number of comorbidities, 95% CI 0.93-0.95, p\0.001; infection: OR 0.88, 95% CI 0.87-0.88, p\ 0.001), alcohol (trauma: OR, 2.3, 95% 2.2-2.4, p \ 0.001; infection: OR 1.5, 95% CI 1.5-1.5, p \ 0.001), opioid (trauma: OR 2.9, 95% CI 2.7-3.1, p\0.001; infection: OR 4.4, 95% CI 4.3-4.4, p \ 0.001) and nonopioid drug abuse (trauma: OR, 2.0, 95% CI 1.9-2.1, p \ 0.001; infection: OR 2.8, 95% CI 2.8-2.9, p \ 0.001), psychosis (trauma:Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. 3, 95%CI 1.2-1.3, p\0.001; infection: OR 1.3, 95% CI 1.3, 1.4, p \ 0.001), and AIDS/HIV infection (trauma: OR 1.5, 95% CI 1.2-1.8, p\0.001; infection: OR 1.3, 95% CI 1.3-1.4, p \ 0.001). Patients with upper...

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Discharge against medical advice: How often do we intervene?

Cited by 30 publications

References 12 publications

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap?

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

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